# Development of Eosinophilic Granulomatosis With Polyangiitis Despite Anti–Interleukin‐5 Receptor Therapy: The First Case of Bilateral Central Retinal Artery Occlusion During Benralizumab Treatment

## TL;DR

A 61-year-old man developed a rare eye condition while on benralizumab, showing that this treatment may not prevent vasculitis in eosinophilic granulomatosis with polyangiitis.

## Contribution

First reported case of bilateral central retinal artery occlusion during anti–interleukin-5 receptor therapy in EGPA.

## Key findings

- Bilateral central retinal artery occlusion occurred in a patient on benralizumab for EGPA.
- Systemic inflammation resolved with immunosuppressive therapy, but visual loss persisted.
- Anti–interleukin-5 receptor therapy may not prevent vasculitic complications in EGPA.

## Abstract

Here, we describe a rare presentation of eosinophilic granulomatosis with polyangiitis (EGPA) under benralizumab therapy manifesting as bilateral central retinal artery occlusion (CRAO). The patient, a 61‐year‐old man with chronic eosinophilic rhinosinusitis and severe asthma, experienced sudden bilateral visual loss and transient amaurosis. Ophthalmologic evaluations, including a fundus examination and optical coherence tomography, confirmed CRAO, and laboratory test results revealed elevated markers of inflammation and positive antimyeloperoxidase antibodies in the context of normal eosinophil counts. Intensive immunosuppressive therapy led to resolution of systemic inflammation, although significant visual impairment persisted. These findings underscore the potential limitations of anti–interleukin‐5 receptor therapy in preventing vasculitic complications in EGPA.